Affidavit of Change of Address

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REPUBLIC OF THE PHILIPPINES )

CITY OF MANILA ) S. S.

AFFIDAVIT OF DISCREPANCY

I, FLORDELIZA LABIOS CADIZ, Filipino, of legal age, married, and


with residence and postal address at 77 Auditing Street, Project 8,
Quezon, City, Manila, after having been duly sworn to in accordance with
law, depose and state, that:

1. I was born on 25 April 1971, in Bo. Hibanga, Saryaya Quezon,


to Angelito N. Labios and Herminia Garcia Reyes, attached herewith as
Annex “A” is my birth certificate;

2. In my Birth Certificate, my mother’s name was erroneously


spelled or registered as “MYRNA” G. REYES when the latter being used
by my mother is “HERMINIA” G. REYES, in all her credentials, records
and other pertinent documents since childhood. A copy of her birth
certificate and birth certificate of her sister, EMILITA GARCIA REYES are
herein attached as Annexes “B” and “C”;

3. I am executing this affidavit to attest to the truth of the


foregoing fact and for circumstances surrounding the discrepancy with
respect to the name of my mother written in my birth certificate to the
fact that “HERMINIA” G. REYES and “MYRNA” G. REYES, pertain and
refer to one and the same person and in relation to my application for a
Japan Visa.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 7 th


day of May 2012, at the City of Manila, Philippines.

FLORDELIZA LABIOS CADIZ


Affiant

SUBSCRIBED AND SWORN to before me this 7th day of May 2012 at the
City of Manila, Philippines, affiant exhibiting to me her Passport ID No.
EB1986887, issued on 28 February 2011, and expires on 27 February
2016, issued by the Department of Foreign Affairs, Manila, bearing
photograph and signature.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2012.

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